Mental Capacity (Amendment) Bill [Lords]

Debate between Dan Poulter and Baroness Keeley

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Barbara Keeley]

It is not helpful if the Minister and I argue about this. We have had this argument enough times in Committee. She just needs to see that there is a level of concern. I am quoting a case where significant harm was done to a young person in a care home because the parents were not listened to and the care staff were.

[Dr Poulter]

I can understand where the hon. Lady’s concerns come from, but having had detailed discussions with my hon. Friend the Minister, I am reassured, perhaps more than the hon. Lady, by the systems and some of the amendments that have been put in place to take into consideration concerns about conflicting provider interest. She makes a good point on the lack of funds and resources and cash-strapped local authorities. Without the money to support local authorities, there is a real risk that scrutiny of care homes and the processes in place under the legislation will be sadly lacking, to the detriment of people under deprivation of liberty orders. What reassurance has she had, if any, during the passage of the Bill that the funding crisis affecting social care and local authorities is being addressed by the Government, both in respect of this legislation and otherwise?

[Barbara Keeley]

I thank the hon. Gentleman for that question. We have had no reassurances whatever. In fact, since the Committee finished, £1.3 billion has been taken out of central Government funding to local councils. Whatever our position was when we were in Committee, things are now much, much worse.

The Minister does not agree, but it is disturbing that we are still in the position on Report of trading the arguments back and forth. We gave lots of examples. There is provision in the Bill for an approved mental capacity professional. With our amendment we want to be sure that we do not have cash-strapped local councils delegating responsibility. There is talk under some amendments to bring in reviews, but reviewers have to be able and willing to stand up to care home managers, and that is a difficult thing.

As my hon. Friend the Member for Bridgend (Mrs Moon) said earlier, care home managers have a lot of power. They have the power to evict and the power to stop visits. Amendment 49 would work with amendment 50 to address the role that the care home manager could play. It is one of the most concerning provisions in the Bill, and it must be addressed if the new liberty protection safeguards are to be fit for purpose.

I do not in any way want to stigmatise care home managers, but I ask Government Members to accept that we are talking about a situation where at least 20% of care homes require improvement or are rated inadequate. Care home manager vacancies are at 11%. We are not talking about a situation where all care homes have a proper care home manager in place, or where they are all doing as well as they could. If the Minister reads many CQC reports, she will see that care homes often fall down on care planning. CQC inspectors often find that there is not a proper or adequate care plan for the situation.

Mental Capacity (Amendment) Bill [Lords]

Debate between Dan Poulter and Baroness Keeley

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Barbara Keeley]

The Minister says no, but Lord O’Shaughnessy in the House of Lords would not consider amendments tabled by two parties to deal with that issue. It is plainly wrong and represents a very clear conflict of interest.

Moreover, the Bill currently allows for the deprivation of someone’s liberty to be authorised for up to three years without review after two initial periods of 12 months, as the Secretary of State said earlier. It cannot be right to have that period of three years without renewal. The Bill is reducing the protections afforded by the current DoLS system, which operates a maximum period of 12 months before renewal.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

The hon. Lady is outlining, with some good reason, the fact that there may be fewer safeguards and fewer opportunities for people to review or appeal under this Bill than when someone is sectioned under the Mental Health Act. She has a point about the need to look into that point, and to look more broadly at how this Bill sits alongside the Mental Health Act, given Simon Wessely’s review. Does she agree that a pause would be helpful to consider the interface of those pieces of legislation?

[Barbara Keeley]

Very much so. I will come on to that shortly, but I will not leave the point about independent hospitals, because it is important.

We know only too well from media reports, and the Secretary of State does too, of the torrid situation in independent hospitals that detain people with autism and learning disabilities under the Mental Health Act, and the measures in this Bill could have disastrous and far-reaching consequences. I have raised at the Dispatch Box on several occasions the appalling treatment of people with autism and learning disabilities in assessment and treatment units. I have described the situation as amounting to a national scandal, and I believe that it is still so. As many as 20% of people in these units have been there for more than 10 years. The average stay is five and a half years. The average cost of a placement in an assessment and treatment unit for people with a learning disability is £3,500 a week, but the costs can be as high as £13,000 a week or more.

As the journalist Ian Birrell has exposed in The Mail on Sunday, private sector companies are making enormous profits from admitting people to those units and keeping them there for long periods. Two giant US healthcare companies, a global private equity group, a Guernsey-based hedge fund, two British firms and a major charity are among the beneficiaries of what campaigners have seen as patients being seen as cash cows to be milked by a flawed system at the expense of taxpayers. According to a written answer I obtained from the Department of Health and Social Care, in the past year alone the NHS has paid out over £100 million to private companies for these placements. Shamefully, the Government cannot reveal how much they have spent since they came to power, because they claim that they did not record the expenditure before 2017. It cannot be right that the Bill potentially gives private companies the power to lock up vulnerable people for years at a time to feed a lucrative and expanding private health sector.

I would like to draw attention to one more issue that the Bill does not address—we have already discussed it—and that cannot be papered over by amendments. The Government commissioned Professor Sir Simon Wessely to lead a review of the Mental Health Act, which is of course long overdue for reform. However, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said, there is clearly a complex interface between the Mental Capacity Act and the Mental Health Act. Professor Sir Simon Wessely has made the point that there is now a worrying trend of people, particularly with dementia, being detained under the Mental Health Act when their deprivation of liberty should be dealt with under the Mental Capacity Act. His review recommended imposing a new line of objection to determine who should be treated under which legislation, but, as the hon. Gentleman said, there has been no engagement with these recommendations, which were finalised as this Bill was going through the House of Lords.

In our view, the Government must commit to a review of the interface between the two Acts, with full consultation, which has, to date, been sorely lacking. It is one thing to say that Sir Simon had a conversation with the Secretary of State about this, but that is not full consultation. The consultation must look at both hospital and community settings and provide clear and accessible rights of appeal.

NHS (Government Spending)

Debate between Dan Poulter and Baroness Keeley

Wednesday 28th January 2015 Commons Chamber

[Dr Poulter]

Through the “Agenda for Change” settlement, many nurses will receive an incremental pay rise worth an average, I think, of between 3.2% and 3.4%. On top of that, we have come to an agreement with the unions to give a 1% rise, particularly to the lower paid NHS staff. That is something I hope the hon. Lady welcomes. It is worth highlighting that one of the biggest things that supports front-line staff is increasing numbers. In Plymouth Hospitals NHS Trust, the number of hospital doctors since 2010 has increased by 25 and the number of nurses by 62. That shows that the investment we are making at national level is paying dividends at local level in her trust.

[Barbara Keeley]

Will the Minister give way?

[Dr Poulter]

I am going to make some progress and I am sure I will give way to the hon. Lady later on.

The investment we are making in the NHS also means that our NHS is caring for more patients than it has ever done before. Last year, compared with Labour’s last year in office, there were 1.2 million more episodes of in-patient care, including 850,000 more operations, 6.1 million more out-patient appointments, 3.6 million more diagnostic tests and almost 460,000 more GP referrals seen by a specialist for suspected cancer, meaning that under this Government more patients are receiving early referral for important care. We have also reduced the number of administrators in our NHS by 20,000. That is freeing up more cash to be reinvested in the front line of patient care.

--- Later in debate ---

[Dr Poulter]

Well, I am a doctor. It is a pity there are so many professional politicians in the Labour party. Had they experience of real life, they might be able to make a more valuable contribution to debates in this place.

In 2015-16, funding for front-line NHS services in England will be £2 billion higher. Of this additional funding, £1.5 billion will go to local NHS services to meet the ever-growing demand for services and to provide better care for the frail elderly and people with long-term medical conditions, such as heart disease and dementia. In addition, £200 million will go towards piloting new care models set out in NHS England’s “Five Year Forward View”; £250 million will provide the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities; and about £30 million will go to the NHS to develop the best approaches to caring for young people with eating disorders in both in-patient and community settings—which further answers the question from the hon. Member for Liverpool, Wavertree by confirming this Government’s commitment to providing better care for people with mental illnesses.

[Barbara Keeley]

rose—

[Dr Poulter]

I will give way one more time, but after that I will not give way for a while, as I want to make some progress.

[Barbara Keeley]

I thank the Minister for giving way, particularly as he is a doctor. He never took into account my real-life experience in IT when we debated care.data, so he wants to be careful about saying that people do not have real-life experience—several of us have real-life experience in different industries, but he does not take that into account.

--- Later in debate ---

[Barbara Keeley]

Will the Minister address the issue of delayed discharges and the impact of cutting community resources? We have touched on social care in general practice, funding for which has really been cut, but the big issue that comes up again and again before the Health Select Committee concerns the loss of thousands of district nurses. I heard yesterday that in the north-west agencies do not even have supply district nurses. Will he address the matter of those community resources? He is talking about community care for the elderly and vulnerable. What will be done about district nurses?

[Dr Poulter]

As the hon. Lady will be aware, front-line staff use IT and understand the importance of joining it up to benefit patient care while also protecting confidentiality. On the point about district nurses, she is right that we need to transform the model of care, which is why the Government set up the £5.2 billion better care fund—to ensure we join up more effectively what happens between our acute hospitals, the wider NHS and adult social care. This approach will be transformative, delivering better care for the frail elderly and providing more care in people’s homes.

Of course, part of that is about changing work force models and ensuring that staff who have traditionally worked only in hospitals, supporting people with long-term conditions such as multiple sclerosis, can also work in the community. [Interruption.] The hon. Lady is chuntering away, but I have answered her question in an informed and sensible way, having spoken about how our work force models need to change as part of our investment in integrating and joining up care so that patients looked after now in a purely hospital environment can have access to staff across both community and hospital care, which is important for people with long-term conditions such as diabetes, multiple sclerosis and dementia. I hope she can support that.

It is also important to consider some of the equally important funding decisions we have made in maternity care. In 2013-14, we provided £35 million of capital funding for the NHS to improve birthing environments, which represents the single biggest capital investment in maternity care for decades. That has benefited more than 100 maternity units, including through the establishment of nine new midwifery-led birthing centres in eight areas, and transformed many local maternity services across the country. Improvements delivered by our maternity investment fund include: more en-suite bathroom facilities in more than 40 maternity units, providing more dignity and privacy for women; more equipment such as beds and family rooms in almost 50 birthing units, allowing dads and families to stay overnight and support women while in labour or if their baby needs neonatal care; and bereavement rooms and quiet areas at nearly 20 hospitals to support bereaved families after the thankfully rare but always tragic loss of a baby.

Our £35 million maternity investment has made a big difference to the experience mums and families have of NHS maternity services.

Oral Answers to Questions

Debate between Dan Poulter and Baroness Keeley

Tuesday 21st October 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Between 2010 and 2013, 52,528 new pre-registration nurse training places were filled, and this year Health Education England has made 19,206 new places available.

[Barbara Keeley]

It is interesting that the Secretary of State cannot follow his own advice about not making operational matters in the NHS political footballs. Perhaps we can try again. The number of nurse training places has been cut by thousands since 2010—a key issue given the need of hospitals to reach safe staffing levels. The Royal College of Nursing has said that Labour’s plans for 20,000 more nurses are absolutely necessary. Does the Minister agree?

[Dr Poulter]

It is right that hospitals respond when there are not enough staff working there, if that is affecting patient care. That is why under this Government 2,500 more nursing staff are working now than in 2010. That is progress to ensure that we are facing up to challenges in care where they exist at local hospitals.

Oral Answers to Questions

Debate between Dan Poulter and Baroness Keeley

Tuesday 1st April 2014 Commons Chamber

[Dr Poulter]

I think this is an own goal from the Opposition. They set the redundancy terms in 2006, when the shadow Secretary of State was a Minister in the Department, which have allowed extraordinary, eye-watering redundancy payments to be made, particularly to managers. That is to the disadvantage of front-line staff and patients. It is why we are currently in negotiations with the unions to ensure that we improve redundancy terms, stop those eye-watering payments and have more money to care for front-line patients.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

21. Talking of eye-watering payments, may I refer to the six-figure pay-off of £300,000 reportedly paid to Jo-Anne Wass, one of the 10 highest earners in the NHS? Despite the fact that she is leaving this month, the NHS is said to be paying for a two-year secondment for her, even though she will not return. How many 1% pay rises for nurses could be found out of that £300,000?

[Dr Poulter]

These are questions that the Opposition should have thought about—the hon. Lady was a Minister in the previous Government—when they negotiated the redundancy terms. They are Labour’s redundancy terms, which we are changing. When we look at the figures, under the previous Government’s NHS reorganisation in 2006 to 2008, we see that the NHS spent more than £360 million on redundancy and early retirement alone, which compares with only half that—£178 million from 2011 to 2013—under the current Government. How much more money would have been available for staff pay had the previous Government got that right?

NHS Patient Data

Debate between Dan Poulter and Baroness Keeley

Tuesday 25th March 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve with you chairing the debate, Ms Dorries. In some ways, I wish that we had new issues to discuss; many of the issues that we are discussing today we have thrashed out on a number of occasions in the Care Bill Committee and the Report debate earlier this month, so I am not convinced that there is a lot of new information that I can bring, other than giving further reassurances along the lines of those that have been given. However, it is important to make two points at the outset.

I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on initiating the debate and on her ongoing interest in this topic, but if she has concerns about a witness not giving correct information to the Select Committee, it is of course at her disposal to speak to its Chair, my right hon. Friend the Member for Charnwood (Mr Dorrell), and ask him to take that up with the witness. If she has those concerns, I suggest she does that. Of course, it is very easy to take comments—a few sentences—out of context. It may be that that is the case here; it may be that there are genuine concerns, but if the hon. Lady has those, it is for her to take them up with the Chair of the Committee and ask him to take the matter further.

[Barbara Keeley]

Will the Minister let me clarify the point?

[Dr Poulter]

I will give way in one moment. It is also the case, in relation to a number of the other issues and concerns that have been raised during this discussion, that some of the events and some of the evidence given to the Select Committee have of course been superseded by the amendments made to the Care Bill that we debated a couple of weeks ago, so it is difficult to see those points—

[Dr Poulter]

I am giving way to the hon. Gentleman’s hon. Friend in one moment. Let me complete the explanation and then I will be very happy to give way. Events have moved on since some of those evidence sessions, because of course amendments were made to the Care Bill that gave greater clarity and greater reassurance about the protection of patients’ data.

[Barbara Keeley]

Before the Minister moves off the point about the misleading evidence given to the Health Committee, may I put this to him? The Minister was there with Max Jones and Tim Kelsey—they were there supporting him at the Committee—and I think that this really is down to the Minister. I have, of course, raised the matter with the Chair of the Select Committee, but if a Minister brings civil servants and NHS employees with him to a Committee and those civil servants mislead the Committee—giving incorrect answers not once but twice—I think that it is really down to the Minister to raise the issue as well.

--- Later in debate ---

[Dr Poulter]

It is difficult to reply fully to such debates when we have very lengthy interventions, of which the hon. Gentleman is very fond. I would like to spell out to him what the quantum difference is. The Government have, through the 2012 Act, put in place safeguards for data protection that the previous Government never had. In particular, under the 2012 Act, data can be used only for the benefit of the health and social care system. We have put in place the safeguard that people can opt out from having their data collected and used. Those safeguards were not in place when the previous Government—

[Barbara Keeley]

Will the Minister give way?

[Dr Poulter]

No, it is important to make these points. The hon. Lady is very party political on the matter, and it is important that she recognises failings that existed in the past. I have mentioned the collection of in-patient data from 1989, out-patient data from 2003 and A and E data from 2007-08. I am not aware of any safeguards put in place by the previous Government to allow patients actively to opt out of the collection of those data. If she is aware of any, I would like her to clarify the record.

[Barbara Keeley]

The Minister is talking about opt-out, but I asked him a specific question about commercial reuse licences. I understand that there are at least six of those—six massive copies of all hospital episode statistics data—out there. How does an NHS patient get their data deleted from those copies, which sit with companies such as Harvey Walsh and OmegaSolver? How does that happen?

Care Bill [Lords]

Debate between Dan Poulter and Baroness Keeley

Tuesday 11th March 2014 Commons Chamber

[Dr Poulter]

Of course strict criteria are in place under the 2012 Act about the use of data where a patient could be identified. The Health and Social Care Information Centre cannot randomly release data that would identify patients, except where there are specific public policy reasons for doing so, such as in the event of a flu pandemic or a public emergency. There are strong safeguards in place under that legislation to protect patient data. It would be wrong of the hon. Gentleman—I know he often inadvertently misleads himself in some of his conclusions and goes around in circles in his remarks—to confuse Members and to confuse the House. The legislation is clear. He has been in many debates on the matter over the past few weeks, and strong protections are in place to protect patient confidentiality and to prevent patients from being inappropriately identified.

I do not want to be drawn into individual cases, but the hon. Member for Worsley and Eccles South also raised the issue of the MedRed BT Health Cloud, which will provide public access in the United States to 50 million de-identified patient records from the Health and Social Care Information Centre in the UK. We have clarified the matter. The data referred to are not confidential, but are published anonymous data of the aggregate population—not at patient level. The data are available freely to any member of the public or organisation via data.gov.uk. There is no conspiracy about the data; they are freely available to any one of us in this Chamber or to any member of the public.

It is worth highlighting the powers of the Secretary of State, which the shadow Minister also raised in his comments. Let me reassure the hon. Member for Worsley and Eccles South in respect of the amendment that she has tabled today. Section 245 of the 2012 Act enables the Secretary of State to direct the Health and Social Care Information Centre to establish information systems—to collect data—including systems on how to carry out that collection.

The Secretary of State can also direct the Health and Social Care Information Centre to report on any matter about its functions. If concerns were raised about the issue of free text data, which my hon. Friend the Member for Totnes mentioned, the Secretary of State could pass on directions to the Health and Social Care Information Centre.

[Barbara Keeley]

The Minister referred to my manuscript amendment on parliamentary oversight of the actions of the HSCIC. I tabled that amendment late because there is a belief that the Secretary of State and the Minister have not been asking the right questions. It has taken the Health Committee and other Members making inquiries to bring out all the issues. We need to keep on doing that, which is why I tabled that important amendment. There was not time to do it in a timely way, but that is why it was done.

[Dr Poulter]

As a Member of the previous Government, it is a pity that the hon. Lady did not take these issues more seriously at the time. It has been left to the current Government to fix the problem through the 2012 Act and the amendments that we have tabled today. That is not good enough and she knows it. It is also the case that she has not read the 2012 Act properly, because I have just outlined the section 245 powers that the Secretary of State has. That is parliamentary oversight in anyone’s terms.

Finally, let me turn to amendment 29 tabled by the hon. Member for Copeland (Mr Reed). As he has said:

“The importance of such data in medical research, and in the synthesis of new treatments and better care, cannot be overstated. In research terms, more information about how people with certain conditions react to treatments can led to better research being undertaken, which uses resources more efficiently and improves a patient’s quality of life.” ––[Official Report, Care [Lords] Public Bill Committee, 30 January 2014; c. 513.]

I completely agree with that. It is important that we uphold a person’s right to confidentiality while enabling the use of information to improve the current and future health and care of the population, with appropriate safeguards to protect confidentiality.

The Health Service (Control of Patient Information) Regulations 2002 made under section 251 of the National Health Service Act 2006 modify the common law obligations of confidentiality. It allows researchers, public health staff and other medical practitioners to access information where there is no reasonably practicable way of obtaining consent to use such information for the purposes of medical research. That is in the interests of improving patient care or in the public interest.

Amendment 29 requires the Secretary State to give approval for the processing of confidential patient information for research purposes. In January 2011, the Academy of Medical Sciences published a review of the regulation and governance of health research. It criticised the complexity of the arrangements for regulating the use of patient information, saying that they are a significant barrier to research. None of us in this House wishes to put barriers in the way of medical research. The Secretary of State has already delegated the function of the approval of processing confidential patient information for research purposes to the existing Health Research Authority special health authority. The 2002 regulations as amended by this Bill would give the new HRA this function directly.

Under this Bill, the HRA would be responsible for overseeing the ethical review of health and adult social care research. As access to patient information may involve the consideration of ethical issues, it makes sense for the HRA to make decisions on applications for access to confidential patient information for research purposes.

Robust legislative safeguards ensure approval for access to patient information for research purposes is given appropriately by the HRA. These include a condition that the HRA may approve processing of patient information for research purposes only if approval has been given by a research ethics committee, established or recognised by the HRA, and a requirement that the new HRA appoints an independent committee to provide advice on applications to process patient information. This provides continuity for the committee known as the confidentiality advisory group, which I spoke about earlier in my opening remarks.

Care Bill [Lords]

Debate between Dan Poulter and Baroness Keeley

Monday 10th March 2014 Commons Chamber

[Dr Poulter]

I hope that I have already given the hon. Gentleman some reassurance that the data will have to be used for the benefit of the health and care service, or for the purposes of public health. They are not to be used for insurance purposes, for example. I will go on to outline some of the safeguards involved.

[Barbara Keeley]

Would the Minister like to comment on an announcement made at the launch of the MedRed BT health cloud—a cloud data system that is using our hospital episode statistics data—in the United States? At the launch, it was stated:

“People are using foreign data because it’s available. The UK made some gutsy decisions about data liberation. There’s political risk associated and they have a more tolerant climate over there.”

Will the Minister comment on the fact that we apparently have such a tolerant climate that MedRed and BT are now charging for access to our data on that cloud system in the United States?

[Dr Poulter]

I am not going to be drawn into commenting on an American system. The point is that there are strong safeguards under the 2012 Act to ensure that confidential data can be used only for the benefit of the health and care system. Of course, data that do not identify patients need to be used in a transparent way that can help to drive up care and services.

[Barbara Keeley]

rose—

[Dr Poulter]

I have been generous in giving way to the hon. Lady; I hope that she will let me address her point. It is important that we have data that are open and transparent and that are used to expose the quality of care that is available from different health care providers. We are one year on from the Francis inquiry, and we need open and transparent data in order to understand and compare the quality of care services in hospitals and in different NHS health and care providers. This is about helping us to recognise what good care looks like, so that we can extend it throughout the system. It is also about exposing the few examples of bad care in an open and transparent way. If we had—

[Barbara Keeley]

rose—

[Grahame M. Morris]

rose—

--- Later in debate ---

[Dr Poulter]

It is clear that the information can be used only for the benefit of the health and care service or for the purposes of promoting health. It is about benefits to the NHS or to the health and care system. That is also what the 2012 Act identifies regarding provision of data. Let us not forget that we had to put safeguards in place because at no point did the previous Government place any restrictions on the use of data. Under the previous Government’s regulations, before this Government came to power, there was greater potential for abuse of the system. Although I am sure the previous Government would not have intended data to be used by private health care companies for insurance purposes or by others, less rigid safeguards were in place to prevent that from happening.

This Government, both with the amendments and the 2012 Act, have clearly stipulated that the information can be used only for the benefit of the health and care system or the health service. That is very clear and the previous Government never put such a provision in place. This Government have also given patients an opt-out in the use of data—something the previous Government never properly put in place. We have introduced good provisions about protecting confidentiality and using information in the NHS in a responsible manner. If the previous Government had been concerned about the use of data, they should have put in place more robust safeguards when they were in power, but they did not.

[Barbara Keeley]

Will the Minister give way?

[Dr Poulter]

No, the hon. Lady has had many interventions; I have been very generous—[Interruption.] I know she does not like hearing about Labour’s record in government on these issues, but I am afraid she needs to. This Government are putting in place safeguards to protect patient confidentiality. The previous Government failed on that agenda, and I am proud that we are able to table these amendments, which will lead to greater reassurance.

The amendments also help to clarify how data can be disseminated to support research for health and care commissioning, health and public health purposes, medical purposes, or other purposes relating to the provision of health care, adult social care or the promotion of health.

Government amendment 8 relates to the remit of the Health Research Authority. It has always been our intention that the HRA’s functions relate to health research and adult social care research, and the amendment clarifies that remit. It makes explicit that the HRA’s functions do not generally extend to research that relates to children’s social care, if that research is solely for the purposes of children’s social care. We must recognise that research may take place across the boundaries between health or adult social care and children’s social care, and the amendment will not inhibit such research. Although the HRA’s functions will not generally extend to children’s social care, the research ethics committees that the HRA establishes or recognises under clauses 113 and 114 will be able to consider children’s social care research in the round when considering a study that also involves health research or adult social care research.

A lot of research crosses health and social care, and some of it involves children. Where such research includes health elements, it already comes to the HRA special health authority for ethical consideration. Many university ethics committees accept HRA ethics committee approval and do not require separate approval by their own ethics committees. That will continue when the HRA becomes a non-departmental public body.

Paragraph 12(5) of schedule 7 gives the HRA a general power to do anything that appears to be necessary or desirable for the purposes of, or in connection with, the exercise of its functions. That power means that HRA can, if it feels it necessary or desirable, publish guidance that relates to children’s social care research where there is also an adult social care element or a health element that falls within the HRA’s remit.

Francis Report

Debate between Dan Poulter and Baroness Keeley

Wednesday 5th March 2014 Commons Chamber

[Barbara Keeley]

Indeed, and our most recent inquiries in the Health Committee are about mental health issues. There is a series of issues that need to be looked at. It is rare in a health debate for me not to mention carers. We need to be realistic about the fact that we are now putting a huge amount of pressure on those carers. Removing social care packages will affect our local hospital, but it will also affect those family members, because in the end who is the person who cares? It is the family member to whom the role falls.

To conclude the point about staffing issues in A and E, we found in our earlier inquiry that fewer than one in five emergency departments were able to provide consultant cover for 16 hours a day during the working week, and the figure is lower at weekends. The whole issue of mortality rates is very much linked to that, and we cannot ignore it. We must keep focusing on the problem with recruitment and the lack of consultant cover.

My right hon. Friend the shadow Health Secretary referred to the warnings by the president of the College of Emergency Medicine. During the time when the college was warning about these issues, Ministers were tied up in knots by the challenges of reorganisation. That is key. Ministers have insisted that they are acting now, but it is clear that those warnings from the CEM in 2010 did not get enough attention until recently. The staffing situation can hardly improve when so few higher trainee posts in emergency medicine are being filled. In the latest recruitment round, 156 out of 193 higher trainee emergency medicine posts went unfilled.

My final point is about the difficulties caused by the cost of the NHS reorganisation reforms. In the past few months the spotlight has fallen on unnecessary spending and waste. We all should be concerned about that. We know that emergency departments are spending £120 million a year on locums, and this could be getting worse. The Health Committee has also recently focused on redundancy costs, which have absorbed £1.4 billion of NHS funding since 2010, with £435 million attributed just to restructuring costs. The scandal of the scale of redundancy payments to NHS staff was made worse when we found out that such a revolving door was in operation. The Health Committee was told that of 19,100 people made redundant by the NHS, 3,200 were subsequently rehired by the NHS, including 2,500 rehired within a year and more than 400 rehired within 28 days. There were reports of payments of £605,000 made to an NHS executive whose husband also received a £345,000 pay-off, with both reported to have been subsequently rehired elsewhere in the NHS. That is a scandal. I know that the Minister said it would not happen again, but that is £1 million that could have been spent on patient care.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Will the hon. Lady give way?

[Barbara Keeley]

I would prefer not to. That money could and should have been spent on improving staffing, particularly nursing staffing. Those patients and family members who have been let down by NHS failures, of which we have heard innumerable examples, deserve to know that everything possible is being done to avoid such failures in future.

Of all the things I have talked about, safe staffing is crucial, as is transparency and staffing ratios. We increasingly have to take on board the fact that there is a funding gap in both the NHS and social care. Indeed, the chair of the British Medical Association said in his new year statement that the funding gap in the NHS is so bad that if the NHS was a country, it would not have even have a credit rating. That is what we are facing.

Patient Medical Records

Debate between Dan Poulter and Baroness Keeley

Tuesday 4th March 2014 Westminster Hall

[Dr Poulter]

My hon. Friend makes an important point. It is also important to highlight that sections 263 to 265 of the 2012 Act put much stronger safeguards in place. Those sections state that processes must be in place in the Health & Social Care Information Centre to ensure confidentiality and to ensure that data are always handled in the right way. The body is responsible for ensuring that those processes are kept up to date and that there are accountability frameworks for those processes. That important step forward was not in place for the previous body.

[Barbara Keeley]

Will the Minister give way?

[Dr Poulter]

I hope the hon. Lady will forgive me, but I want to make progress on some of the points raised in this debate. I will have to be brief any way, and she had a good chance to question me when I appeared before the Select Committee on Health last week. If she feels that she did not have an opportunity to discuss all of the issues, I am sure she will have an opportunity next week when we discuss these matters in our consideration of the Care Bill. Amendments were tabled last night to support some of the issues that we are talking about today. Those amendments will be considered next week, and I am sure those Members who cannot contribute in greater detail today because of the time will be able to contribute much more fully to next week’s debate.

Finally, it is important to talk about driving and supporting integrated, joined-up health and social care across the system, in which we all believe. I know that those Members who are members of the Health Committee believe in that because I remember being a member of that Committee with the hon. Lady and the hon. Member for Easington. If we are to deliver better integrated care, we need to have the right data. One of the key challenges in the past is that we did not collect the data effectively to measure what good integrated care looks like. We know we need to improve the collection of those data, and we want people with long-term conditions such as diabetes, dementia and asthma to be better supported in their own homes and communities. Of course we need to have the data to do that. A lot of those data will come from primary care, and it is important that we put together those data and analyse them to understand what good care looks like. We have not been in the right place to deal with that in the past, but I am confident that we will be in the right place to do it while protecting patient confidentiality with the measures that we are seeking to implement.

[Barbara Keeley]

The point that I wanted to make is in line with what the Minister is saying. Following the revelations about IT issues that I mentioned, and the apology that his colleague the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) made yesterday to the Commons, will he now agree that it would be sensible for Ministers and NHS England to consider keeping one copy of the care.data database and run staff queries against it, so that it is held in one place and not scattered about on various servers, causing consternation and the need for websites to be taken down, as they were yesterday, because NHS England does not know where the hospital data have gone? The only solution is the one that we discussed last week: keeping one copy and running staff queries against it.

[Dr Poulter]

It is absolutely right that the discussions that we have had in this debate and the issues raised about care.data have been helpful in building on the safeguards in the 2012 Act to improve the processes of the Health & Social Care Information Centre, as a new body, to ensure that it has particular regard to putting strong confidentiality criteria in place. It is also right to keep those criteria under regular review. Obviously, there is regular communication between that body and the Information Commissioner about issues such as protecting confidentiality.

I am sure that we have a robust set of criteria in place under the 2012 Act. It may be helpful to hon. Members if I outline what they are. I reassure the hon. Member for Birmingham, Hall Green that the data are not released for profit. It is about cost recovery when they are. It is also important to say that data are not released in identifiable form without a strong public policy reason: for example, in a civil emergency or some such situation. Data must be used for the benefit of the health and care system. That is a strong set of criteria for use of the data, and strong safeguards are in place. My right hon. Friend the Secretary of State has already put in place an opt-out for patients who do not want to be involved in the process, which has not been the case in the past.

It is important in this context to highlight that we are not taking a sudden, big-bang approach or change to data; this is an evolutionary process. In 1989, in-patient data were collected for the first time; in 2003, out-patient data; in 2007 and 2008, accident and emergency data. That was about improving and driving transparency, developing better care pathways for patients with, for example, chronic obstructive pulmonary disease and ensuring that we better used data to benefit the health service and patients. Now, when it is so important to drive better integration, primary care data will also be collected. That is not a revolutionary change; it is an evolutionary change. What is important is that now, under the 2012 Act, we have much stronger safeguards in place better to protect patient confidentiality and much more rigorous processes under which the Health & Social Care Information Centre, as a new body, will operate, in order to ensure that it regularly reviews its processes and uses data in the right way.

It is also important to say that my right hon. Friend the Secretary of State fully supports and is committed to the principles of the programme, which will alert the NHS where standards drop, enable prompt action to be taken, help staff understand what happens to people, especially those with long-term conditions, and help us develop and improve care. However, in order to reassure hon. Members further and bring greater clarity to some of the issues and discussions, we have tabled some amendments to the Care Bill. We will have an opportunity to discuss them fully next week when we debate the Bill. I am sure that when hon. Members see them, in conjunction with the safeguards already in place under the 2012 Act that were not there before, they will be reassured.

The programme is a good one. It is doing the right thing, improving research, driving up care standards in our NHS and supporting the integration of the health and care system, which we all believe in. It is also protecting patient confidentiality. With those reassurances, I close my remarks. I hope that hon. Members will take the opportunity next week to debate fully any further issues or concerns that they may have. I will bring them the reassurances that they need.

Oral Answers to Questions

Debate between Dan Poulter and Baroness Keeley

Tuesday 14th January 2014 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

16. What recent assessment he has made of the effect of social care budget changes on accident and emergency attendances.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Although councils have reduced social care budgets, the evidence suggests that this is not having an impact on the NHS. In fact, the data published by NHS England show that councils are getting better at getting people out of hospital at the appropriate time.

--- Later in debate ---

[Dr Poulter]

There is always a lot of political smoke around this, but spending has roughly been flat in cash terms according to the Association of Directors of Adult Social Services survey and councils are budgeting to spend more this year than they were last year on social care. In addition, we are setting up the integrated care fund of £3.8 billion to better join up health and social care, and that will help to improve the care available to patients as well as reduce pressure on budgets.

[Barbara Keeley]

But Government budget cuts have forced Salford local authority to change its eligibility criteria. For 1,400 people it is going to be zero-day social care, not seven-day social care, and even our excellent Salford Royal hospital is going to struggle when those 1,400 people find that the hospital is the only option for them. Age UK says these cuts make “no financial sense” and are “morally wrong”. When are Health Ministers going to see that point?

[Dr Poulter]

I make two points. First, the eligibility criteria began to change under the previous Government, so it is wrong of the hon. Lady to try to make political points which do not stand up to scrutiny. Secondly, I am disappointed that she is unable to recognise that there is very good integration of health and social care in Salford, in her own constituency. That is a model that we could look at to see how good care can be delivered elsewhere.

Oral Answers to Questions

Debate between Dan Poulter and Baroness Keeley

Tuesday 22nd October 2013 Commons Chamber

[Dr Poulter]

I am very sympathetic to the point made by my hon. Friend. The chief inspector has indicated that he will look at how individual wards are run on a granular level to ensure there is the right skills mix to look after patients on any particular day, with proper accountability for patient care.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The chief inspector of hospitals says he will monitor levels of unanswered call bells, but not the ward staffing levels that cause the bells to be unanswered. Is that not ridiculous? Is it not time that Ministers changed their minds on this important issue, as Robert Francis has now done?

[Dr Poulter]

As the hon. Lady will be aware, on the basis of the Francis report the Berwick review considered that issue in detail and highlighted the fact that safe staffing levels are not about ticking a box for minimum staffing, but about developing tools that recognise the individual needs of patients on the ward. The previous Government went down the route of tick-boxes in health care. I worked on the front line during that time and that route did not deliver high-quality care. We need the right tools to support front-line staff so that they make the right decisions in looking after patients. It is not about tick-boxes; it is about good care.

Managing Risk in the NHS

Debate between Dan Poulter and Baroness Keeley

Wednesday 17th July 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a great pleasure to rise to speak in support of the amendment tabled by my right hon. Friend the Prime Minister.

Both sides of the House believe in our NHS, the staff who work in it and the care they provide for patients. I am also sure that both sides recognise that, in the wake of the Francis inquiry and yesterday’s report from Sir Bruce Keogh, the 65th year of the NHS has been its most challenging and that we need to face up to those challenges.

This debate has had three key themes: the importance of the NHS, the staff who work in it and the care they provide for patients; the importance of making greater productivity gains in the NHS to improve care and make sure that we do more with our resources; and the importance of openness and transparency and the need to learn lessons from things that have gone wrong, so that patient care can be improved.

Back Benchers have made some high-quality contributions. It is always a pleasure to hear the hon. Member for Walsall South (Valerie Vaz) and the right hon. Member for Holborn and St Pancras (Frank Dobson). The hon. Member for Halton (Derek Twigg) made a very strong case for his local health care services. I pay particular tribute to the right hon. Member for Cynon Valley (Ann Clwyd), who has done some tremendous work in looking at how we can improve the NHS complaints procedure. She read out a number of examples of things that have gone badly wrong, from which we need to learn lessons for the future. The work she is doing at the moment is hugely important and valuable, and the Government look forward to receiving her report shortly.

My hon. Friend the Member for Bracknell (Dr Lee) highlighted some of the challenges with the existing NHS estate and the need to modernise facilities and make some of the older buildings more fit for purpose to meet the needs of patients in the modern world. My hon. Friend the Member for Bristol North West (Charlotte Leslie) made a very brave speech. She spoke at great length—and rightly so—about the importance of involving the medical royal colleges in deciding how hospital inspection processes should be implemented and about the importance of clinical leadership and involvement in those inspections to help understand what good care looks like. After all, those colleges are centres of excellence in their fields and it is right that we listen to what they have to say.

My hon. Friend the Member for Southport (John Pugh) made a particularly thoughtful speech. He called for good management and spoke of the need for good managers in the NHS. He also made the important point that, in all our debates on patients who have been let down, the regulators have often not played their part. That is why we need to ensure that the regulators continue to come to the table and that the improvements at the CQC continue. The regulators need to remain fit for purpose.

The problem with mandatory staffing ratios is that they would just provide another tick box that would not necessarily bear a relation to what good clinical care looks like. There is a clear difference between mandatory staffing ratios and appropriate staffing levels, as the Francis report indicated. We need staffing levels that reflect the needs of the patients on the ward. Those will vary from ward to ward and will change on a daily basis according to the needs of different patients. It is important that we consider the patients who are in front of the doctors and nurses on the day. It may not be nursing care that is needed, but care from other members of the multi-disciplinary team such as physiotherapists and health care assistants. That is why it is wrong to use mandatory staffing ratios as a measure of good care.

[Barbara Keeley]

The point that I keep raising with the hon. Gentleman, other Ministers and the Secretary of State is that there must be transparency in the numbers. Ratios of 2:29 have been reported to me, which nobody would be comfortable with. My excellent local hospital puts information about staffing ratios on the boards in each ward. Does he not think that we should move rapidly to provide transparency on this matter? I am asking not for mandated ratios, but transparency so that patients and their families can see what the ratio is.

[Dr Poulter]

The hon. Lady makes a very good point about the importance of having staffing levels that are appropriate to the needs of the patients. That is why NHS England is considering toolkits that will help hospitals to build the right care in the right place and at the right time for patients and to adapt care so that it is provided by the appropriate professionals, according to patient need.

The debate has rightly focused on transparency and openness. We have not got that right in the NHS since the Bristol heart inquiry, which took place under the previous Government. Both the Government and the Opposition believe that we need to support staff who feel that they need to speak out and that there needs to be greater transparency and openness. I believe that the steps that the Government are taking will make a difference. We are introducing a contractual right for staff to raise concerns and issuing guidance on good practice in supporting staff to raise concerns. We are strengthening the NHS constitution and have set up the whistleblowing hotline to support whistleblowers. We are also amending legislation to secure protection for all staff through the Public Interest Disclosure Act 1998. We are doing good work and it is right that we continue to do all that we can to support staff in raising concerns about patient care, where that is appropriate.

We must focus on improving productivity in the NHS so that we can do more with the resources that we have. As the Secretary of State outlined, that is about improving the technology in the NHS so that we can spend more money on care and free up staff time. If we use technology to better join up health and social care, staff will spend less time on paperwork and more time with patients, which will improve patient care.

It is important to consider the fact that there are higher levels of morbidity and mortality at weekends and in the evenings. There needs to be more consultant cover and out-of-hours cover at those crucial times to ensure that the service is more responsive to patients. The Government are addressing that.

In conclusion, at the beginning of this debate, the right hon. Member for Leigh (Andy Burnham) rightly highlighted the long-standing problems in our NHS. Although Labour is now talking about social care, it was the last Labour Government who cut the social care budget between 2005 and 2010. Although Labour is now talking about the risk register, the last Labour Government refused to publish it.

Oral Answers to Questions

Debate between Dan Poulter and Baroness Keeley

Tuesday 16th July 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is right to highlight the fact that the figures show that last year alone 50,000 bed days that would otherwise have been wasted were saved by investing in social care and implementing the service transformation that we all require. However, this is about making all NHS and social care budgets go further, and recognising that if we are to improve the care of older people, particularly frail elderly people, we have to invest in more community prevention and community-based care, which is what this Government are doing.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

As we have heard, two thirds of NHS leaders have said that the shortfall in social care spending is having an impact on their services. The Minister can try to get rid of that and talk it away, but in week after week of taking evidence in our inquiry into emergency care, the Select Committee on Health has heard the same thing. We know that elderly patients now form a much larger proportion of admissions—40% of admissions to emergency units are people aged 65 to 85. Is not the £1.8 billion cut in spending now really hitting NHS services and making the emergency care crisis worse?

[Dr Poulter]

I am afraid that the Opposition are very confused about their figures. As I explained earlier, the £2.7 billion—or 20%—figure represents the savings that councils have made to meet demand, and real-terms spending next year is expected to go up. The point from the ADASS and other surveys is that integration works. This Government are investing in integration. According to the Dilnot report, it was the last Government who cut in real terms the amount of spending going to social care between 2005 and 2010—and the hon. Lady was a member of that Government.

Oral Answers to Questions

Debate between Dan Poulter and Baroness Keeley

Tuesday 26th February 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that all staff in the NHS should feel able to speak up and raise concerns about patient safety, so that the organisations for which they work can take up their concerns and investigate them. He will be aware that the people who raise such concerns are protected under the Public Interest Disclosure Act 1998.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Last week I visited Salford Royal hospital, which has the lowest death and weekend mortality rates in the north-west, and the seventh lowest in the country. It is interesting to note that Salford also has higher ratios of nurses per in-patient bed, and that individual wards in the hospital publish data on their rates of MRSA, ulcers and falls. Does the Minister accept that good practice at hospitals such as Salford Royal should be investigated alongside the poor practice and high mortality rates in other hospitals?

[Dr Poulter]

The hon. Lady is absolutely right. That is exactly what the review is about. It is going into the 14 hospitals in which concern has arisen over mortality data, looking at the practices there and commissioning a peer review of them from leading clinicians and patient groups. That will help to raise standards of practice where required.

Oral Answers to Questions

Debate between Dan Poulter and Baroness Keeley

Tuesday 23rd October 2012 Commons Chamber

[Dr Poulter]

I thank my right hon. Friend for that question. We discussed this issue in the Adjournment debate before the autumn recess. He is a strong advocate for his local maternity services. The concern was that only 13 births take place at his local maternity unit every year, and whether staff can continue to deliver high-quality care with such a low number of births. Of course, his local providers will want to consider the rurality of the area and the potential, as outlined in the Birthplace study, of rotating staff in and out of the hospital to support his local unit.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

7. What steps he plans to take to ensure that providers of domiciliary care employ staff who are properly qualified and security checked.

Cost of Living

Debate between Dan Poulter and Baroness Keeley

Wednesday 16th May 2012 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

There was little, as we have already heard today, in the Queen’s Speech to do with the rising cost of living. We have recently had a Budget that helps millionaires with tax cuts while penalising pensioners and families, and throughout the country people are struggling with the impact of a double-dip recession made in Downing street, so the Government, whether in the Budget or in the Queen’s Speech, are offering little help to those working people or pensioners on modest and low incomes who are struggling to manage.

But I want to talk about the Government’s failure to introduce in the Queen’s Speech a Bill on the financial reform of social care, because it has implications for the cost of living of the millions of vulnerable people who need care. There is also a major effect on carers who drop out of work or reduce their working hours in order to care, because that has an impact on the economy.

First, however, I send best wishes for a speedy recovery to the hon. Member for Truro and Falmouth (Sarah Newton), who I understand has had a fall—an accident here—and is in hospital. She is the vice-chair of the all-party group on social care, and we work well together. This is a vital time for social care, so I am really sorry that she might not be with us for a few weeks, but I wish her well.

Every few weeks we see another article or report about the crisis in social care. The Association of Directors of Adult Social Services has reported cuts of more than £1 billion in local council budgets for adult social care since the general election, with a further £1 billion of cuts expected this year. Those cuts have led to service reductions and to substantial increases in charges.

We learned today from research by my hon. Friend the Member for Leicester West (Liz Kendall) that the number of vulnerable, older and disabled people who have home care services fully paid for by their local authority has fallen by 11% in England over the past two years, and a survey by the Care and Support Alliance also shows that services to 24% of disabled adults have been cut, even though their needs are the same or have increased.

Research by Age UK shows that cuts to council budgets mean increased fees for services. Two thirds of local councils are increasing fees for services such as meals on wheels, and fees have increased by 13% over two years. Almost half of all local councils are charging more or making new charges for home help or day care services, and my hon. Friend’s research shows that the average charge for one hour of home care has risen by 10% in the past two years, from £12.29 to £13.61. On average, older people pay for 10 hours’ home care a week when they are using it, so the annual bill for care has risen to more than £7,000, an increase of £680 since 2010. Yet, as we know as Members of Parliament, these services are a lifeline to many vulnerable people. The Age UK research also showed that one in six councils has reduced personal budgets for care packages and that almost half of councils have frozen the rates that they pay for residential care, leaving older people and their families who pay top-ups to absorb any price increases—and there have been price increases. Care homes have been increasing their fees. The fees for residential care have increased by 5% on average over the past year, taking the average up to £27,200 a year. Nursing home fees have risen by a similar amount and now cost £37,500 a year on average.

In addition, councils are raising or abolishing the caps on the care costs met by individuals who need care. Four out of 10 councils have abolished funding caps in the past two years, with another four out of 10 increasing the cap so that people now have to pay more, while rates charged for respite care have tripled in some parts of the country. My hon. Friend the Member for Leicester West is calling these increased care charges a stealth tax on the elderly and people with disabilities, and I agree. More and more people are footing the bill for care themselves, and that bill has grown. The need for care often starts suddenly and unexpectedly due to a medical event such as stroke or the sudden worsening of a condition such as Alzheimer’s or vascular dementia. That often leads to bills that are very hard to meet. A quarter of people are faced with care costs in their lifetime of over £50,000, with one in 10 paying £100,000. These care costs can be catastrophic. Indeed, more than 20,000 pensioners every year have to sell their homes to pay for residential care.

It is not just a question of care charges, which are bad enough. People needing care often tend to be disproportionately hit by increases in the everyday cost of living. People who are older and frail, or ill or with a disability, spend more time at home and need to keep warm, so increases in heating and electricity bills hit them hard. Besides paying more for care, they have had to cope with VAT increases, higher fuel and travel costs—this group of people spends a lot of time attending GP surgeries and hospital visits—and increased prescription charges. All these have increased the cost of living for people needing care.

Under this equation, reduced care services and increased costs for care ultimately mean that unpaid family carers take on heavier caring workloads. Carers UK has estimated that 1 million carers have given up work or reduced their working hours in order to care. Over two thirds of those who had given up work to care were more than £10,000 a year worse off as a result. Over 45% of the carers it surveyed were cutting back on essentials such as heating or food in order to make ends meet. Sadly, the cost of caring can push carers into debt. Almost half the carers surveyed by Carers UK had fallen into debt. While over half the younger carers had been in debt, for carers over 65 the debts were greater; 15% of them had debts of at least £25,000. Unsurprisingly, the stress of this financial hardship had affected the health of nearly half those carers.

We can therefore say that the need for reform of the funding of social care is urgent. In fact, it is so urgent that 78 charities wrote an open letter to the Prime Minister ahead of the Queen’s Speech reminding him that social care is in crisis. They said that without reform

“too many older and disabled people will be left in desperate circumstances”.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

The hon. Lady is making a very good speech outlining many of the problems with caring for the elderly and the challenges that carers face. Will she accept, though, that while it is right to highlight these problems, the Labour party, when in government for 13 years, did nothing substantially to tackle these problems, many of which have taken a long time to manifest themselves and should have been dealt with under the previous Government when this country had more money?

[Barbara Keeley]

The hon. Gentleman was not here in the previous Parliament. As somebody who was here, I can say that we did take substantial steps. I have been speaking on these issues ever since I came into Parliament in May 2005. With cross-party talks, we came very close to achieving consensus until the Conservative shadow Secretary of State—now the current Secretary of State—walked out on those talks and did a lot of scaremongering in the general election with posters about a “death tax” featuring tombstones. I am sure that Members will remember that.

Moreover, we did not just have a draft Bill; we had the Personal Care at Home Bill, which went through Parliament. That would have helped the 400,000 people with the greatest needs, while 300,000 people with very substantial care needs, such as those with dementia, could have had personal care at home, and over 100,000 people would have been helped with reablement. I know from working with the hon. Gentleman on the Select Committee that he is very keen on dealing with issues such as reablement, for which support would have been provided. Those 400,000 people are now paying for that themselves. They could have been helped if this coalition Government had not got rid of that Bill, which they could have enacted, as it had gone through this House. It is not true to say that we did nothing on this; we did a lot.

[Dr Poulter]

It is wrong to say that Members who came into the House in the 2010 intake do not understand these issues, because many of us, including me, were working in the real world picking up the pieces of the broken care system. The hon. Lady is looking around for little bits and pieces that the previous Government may or may not have done to address the issue. The previous Government had 13 years to deal with these big challenges of elderly care, of better integrating health and social care, and of dealing with the funding crisis. They did nothing substantial to deal with those things; will she accept that?

[Barbara Keeley]

No, I absolutely do not accept that. In our 13 years in government, the first thing we did was to fix the health service following the mess that we inherited from the Conservative Government. We had a lot of other priorities in dealing with what the Conservative Government had done through privatisation. I am amazed that Members are arguing about bus fares and train fares. It was not a Labour Government who privatised these things. All the privatisations and reductions in services came about through Conservative Governments, not Labour Governments. We were tackling these issues.

We now have a Minister for social care who believes that there is no funding gap. He is arguing with all the directors of adult social care services, who say that £1 billion has gone out of adult social care in the past couple of years, with the loss of another £1 billion to come. The crisis that I am detailing as regards the cost of living impacts on individuals and their families is undoubtedly made hugely worse by the £2 billion that is going out of adult social care. However tight things were or whatever struggles were going on during the last Parliament, when I did a lot of work on this topic, it was never said that social care is in crisis, whereas now that is said every single week.

In the open letter to the Prime Minister ahead of the Queen’s Speech, 78 charities reminded him that social care is in crisis. As I said, they feel that older and disabled people will be left in desperate circumstances. There are 800,000 people with unmet needs, and that figure will possibly grow to 1 million. Some people will struggle on alone and do not even have an unpaid family carer to help them.

[Dr Poulter]

I do not always like to quote outside agencies or charities in this House. However, Age UK successfully put together a campaign, with a petition that was handed into Downing street, in which it acknowledged that the chance to tackle this issue was flunked by the previous Government and should have been better dealt with. That was an inherent part of that campaign. This is a creeping crisis that began and was manifested over a number of years, and it is very disingenuous of the hon. Lady to say otherwise.

[Barbara Keeley]

It is very disingenuous of a member of a Government who have just massively ducked this issue in the Queen’s Speech, causing huge disappointment across any organisation that is involved in social care, to talk about the previous Government.

National Health Service

Debate between Dan Poulter and Baroness Keeley

Wednesday 26th October 2011 Commons Chamber

[Dr Poulter]

I thank my hon. Friend for clarifying an earlier point.

I will not engage in mud-slinging, but will talk about what hon. Members on both sides of the House want to emerge from the NHS. The right hon. Member for Leigh (Andy Burnham) was absolutely right that some service reconfiguration is necessary to deliver services in communities, improve community care and build an integrated health service with integrated health care. The right hon. Gentleman spoke specifically about an integrated system and better integrating adult social care, especially for the elderly, with current NHS providers, breaking down some of the silos between primary care, the hospital sector, and adult social services.

[Barbara Keeley]

Was the hon. Gentleman as concerned as I was at the Select Committee on Health on Tuesday when I asked Richard Humphries of the King’s Fund how the Health and Social Care Bill will impact on integrated commissioning? Richard Humphries said that there is a danger to integration because people are leaving PCTs, working relationships are being disrupted and broken up, and partnerships are being disrupted. As my right hon. Friend the Member for Leigh (Andy Burnham) said, we face years of disruption. That is the danger. Progress on the integration agenda was slow, but it is chaotic now.

[Dr Poulter]

I thank the hon. Lady for her intervention. Any period of transition will be difficult, and must be managed. Will the mechanisms and bodies that the Health and Social Care Bill will put in place be better able to deliver community-focused, integrated care than the existing system? I want to consider two matters that we will come to later: health and wellbeing boards, and basing commissioning fundamentally in the community. Both are good mechanisms for delivering better integrated care, and I will return to that.

We have too many silos in the NHS. The primary care sector often does not integrate with the secondary care sector as well as we would like. For example, hospitals are paid by results, but they have no financial incentive to ensure that they prevent inappropriate hospital admissions. We talk about better looking after the frail elderly and about ensuring that we prevent people with mental health problems from reaching crisis point and having to be admitted, but there are no financial incentives and drivers in the system to ensure that that is achieved to the extent we would like. A and E admissions in many hospitals are rising year on year—in rural areas that is partly because we do not have an adequate out-of-hours GP service—and far too often the frail elderly are not properly supported in the community.

If we put the majority of commissioning into the community with local commissioning boards, that will provide a more integrated and joined-up approach to local commissioning, which will undoubtedly help to prevent inappropriate admissions. We no longer want an NHS in which people with mental health problems or the elderly present in crisis because they have not been supported in the community. That must be the focus of care, and the focus of delivery of services.

Health and Social Care (Re-committed) Bill

Debate between Dan Poulter and Baroness Keeley

Tuesday 6th September 2011 Commons Chamber

[Dr Poulter]

The point is—I speak as a front-line doctor who still practises in the NHS—that far too often we see form-filling that gets in the way of our doing our job as doctors in hospitals, and that is not for the benefit of patients.

[Barbara Keeley]

Will the hon. Gentleman give way?

[Dr Poulter]

No, sit down. The hon. Lady should listen to this, because it is important. The point is that doctors and nurses need to be allowed to get on and do their jobs.

A key focus is not just about putting more money into front-line patient care but making sure that we have clinical leadership of services. Form-filling for the sake of it does not benefit patients; what benefits patients is allowing doctors to treat those in front of them. Under the perverse incentives that were created previously, the four-hour wait in A and E means that a patient with a broken toe is just as much of a priority as someone with potentially life-threatening chest pain. That is the problem with the service that we have, and that is why the clinical leadership and focus that this Bill is bringing will be so important.